Study on Hepatitis A Virus and Hepatitis E Virus Co-infection

Abstract

Background: Both hepatitis A virus (HAV) and hepatitis E virus (HEV) are the leading causes of acute viral hepatitis in developing countries due to their poor sanitary conditions and still remain as a significant public health concern. Although these viruses spread by the fecal-oral route or through contaminated water and food, HEV infection can be transmitted through animals to humans and has been recognized as a zoonotic disease. Several studies have indicated that the superinfection of HEV or HAV in patients with hepatitis B or hepatitis C is common and can result in severe diseases and poorer outcomes, which mean emphasis should be placed to take appropriate measures to diagnose and treat those patients. However, there are few studies about the co-infection of HEV and HAV in patients. The aim of the current study was to determine the prevalence of co-infection of HEV and HAV in patients, and to investigate HEV and HAV infection among various animals which can be the potential hosts. Methods & Materials: 46 serum samples of patients diagnosed as hepatitis A or hepatitis E and 555 fecal samples of 12 animal species were collected. Anti-HEV IgM and anti-HAV IgM were detected by enzyme-linked immunosorbent assay(ELISA). HEV RNA and HAV RNA were extracted from serum and fecal samples and amplified by nested reverse transcription polymerase chain reaction(RT-nPCR). Results: 10.9% (5/46) of the patients were co-infected with both viruses (HAV&HEV). 15% (18/120) of rabbit fecal samples and 17.5% (7/40) of swine fecal samples were positive for HEV RNA. HAV RNA was detected in 2.5% (2/80) of ferret fecal samples. Conclusion: This study showed that patients co-infected with both HAV and HEV is not infrequent in our study cohort and ferrets might be the potential animal reservoirs of HAV.